Local recurrence from rectal cancer is a complex problem that should be managed by a multidisciplinary team. Pelvic reirradiation and intraoperative radiation should be considered in the management of these patients. Long-term survival can be achieved in patients who undergo radical surgery with negative margins of resections. The morbidity of these procedures is high and at times may compromise quality of life. Palliative surgical procedures can be considered; however, in some cases, palliative resections may not be better than nonsurgical palliation.